Oral versus intravenous iron therapy in patients with inflammatory bowel disease and iron deficiency with and without anemia in Germany &amp;ndash; a real-world evidence analysis

Stein, Jürgen M.; Haas, Jennifer S.; Ong, Siew Hwa; Borchert, Kathrin; Hardt, Thomas; Lechat, Elmira; Kerry, Nip; Douglas, Fiona; Braun, Sebastian; Baumgart, Daniel C.

doi:10.2147/ceor.s150900

Cited by 18 publications

(9 citation statements)

References 38 publications

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“…Parenteral iron is more expensive and is an additional cost to the healthcare system, which is a limiting factor in its widespread use [ 1 , 47 ]. However, further studies have shown that the long-term costs of ineffective oral iron therapy are outweighed by the immediate costs of IV iron [ 67 ]. Additionally, severe anaphylactoid reactions to HMW dextrans have previously been reported but are now increasingly rare with the newer LMW formulations [ 1 ].…”

Section: IV Ironmentioning

confidence: 99%

Iron Therapy in Inflammatory Bowel Disease

Kumar

Brookes

2020

Nutrients

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The most common complication seen in inflammatory bowel disease (IBD) patients is iron deficiency anaemia (IDA). Symptoms such as chronic fatigue can be as debilitating to IBD patients as pathological symptoms of abdominal pain and diarrhoea. Recognising and correcting anaemia may be as important as managing IBD symptoms and improving overall quality of life. Thus, iron replacement should be commenced the moment IDA is identified. Although intravenous iron is now considered standard treatment for IBD patients in Europe, oral iron still appears to be the preferred option. Advantages of oral iron include greater availability, lower costs and ease of applicability. However, its multitude of side effects, impact on the microbiome and further exacerbating IBD activity can have consequences on patient compliance. The newer oral iron formulations show promising safety and efficacy data with a good side effect profile. Intravenous iron formulations bypass the gastrointestinal tract absorption thereby leading to less side effects. Multiple studies have shown its superiority compared to oral formulations although its risk for hypersensitivity reactions continue to lead to clinician hesitancy in prescribing this formulation. This article provides an updated review on diagnosis and management of IDA in IBD patients, discussing the newer oral and intravenous formulations.

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Section: IV Ironmentioning

confidence: 99%

Iron Therapy in Inflammatory Bowel Disease

Kumar

Brookes

2020

Nutrients

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“…The following clinical observations may answer this question. First, IDA and FIDA frequently occur in autoimmune and inflammatory disorders such as systemic lupus erythematosus (SLE) [ 138 ], RA [ 139 , 140 ] and IBD [ 141 , 142 ]. These disorders are frequently associated with CKD, leading to ESRD [ 143 , 144 ].…”

Section: Impact Of Inflammation On Therapeutic Strategy With Iron mentioning

confidence: 99%

“…Furthermore, patients with IBD having higher levels of CRP achieved a lower Hb response with OIT than those with lower levels of CRP [ 153 ]. Thus, IIT has been more efficacious than OIT in patients with RA, SLE [ 154 , 155 ] and IBD [ 142 ]. Taken together, these data suggest that inflammation in autoimmune disorders and IBD leading to CKD/ESRD may have an impact on the expression of ferritin and hepcidin, the response to iron therapy and mode of iron therapy as well.…”

Section: Impact Of Inflammation On Therapeutic Strategy With Iron mentioning

confidence: 99%

Impact of Inflammation on Ferritin, Hepcidin and the Management of Iron Deficiency Anemia in Chronic Kidney Disease

2018

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Iron deficiency anemia (IDA) is a major problem in chronic kidney disease (CKD), causing increased mortality. Ferritin stores iron, representing iron status. Hepcidin binds to ferroportin, thereby inhibiting iron absorption/efflux. Inflammation in CKD increases ferritin and hepcidin independent of iron status, which reduce iron availability. While intravenous iron therapy (IIT) is superior to oral iron therapy (OIT) in CKD patients with inflammation, OIT is as effective as IIT in those without. Inflammation reduces predictive values of ferritin and hepcidin for iron status and responsiveness to iron therapy. Upper limit of ferritin to predict iron overload is higher in CKD patients with inflammation than in those without. However, magnetic resonance imaging studies show lower cutoff levels of serum ferritin to predict iron overload in dialysis patients with apparent inflammation than upper limit of ferritin proposed by international guidelines. Compared to CKD patients with inflammation, optimal ferritin levels for IDA are lower in those without, requiring reduced iron dose and leading to decreased mortality. The management of IDA should differ between CKD patients with and without inflammation and include minimization of inflammation. Further studies are needed to determine the impact of inflammation on ferritin, hepcidin and therapeutic strategy for IDA in CKD.

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“…The main disadvantage is the higher cost of medication and the necessity for administration by a health professional. However, a study by Stein et al [30] based in Germany found that patient outcome was better with IV iron, with fewer hospitalizations and an overall lower total health care cost as compared to oral iron. The immediate costs of IV iron may thus be offset by the long-term costs of ineffective oral iron therapy.…”

Section: Treatment Of Ida In Ibdmentioning

confidence: 99%

Management of Iron Deficiency Anaemia in Inflammatory Bowel Disease

Jimenez

Gasché²

2019

Acta Haematol

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Inflammatory bowel disease (IBD) is a group of chronic relapsing inflammatory disorders affecting the large and small intestine, with a rising worldwide incidence and prevalence. Anaemia is the most common extraintestinal manifestation of IBD, correlating with disease activity, and tending to relapse even after successful therapy. Iron deficiency is the most common cause; however, it often manifests in combination with anaemia of inflammation. As such, multiple parameters are used for the diagnosis of iron deficiency anaemia in IBD. Timely recognition and selection of appropriate therapy leads to an improvement in the quality of life and prevention of potential sequelae. Oral iron can be effective under specific circumstances; however, as luminal iron changes microbiota and bacterial metabolism, oral administration should be avoided. Intravenous iron is preferred as it bypasses the sites of inflammation. Nevertheless, the optimization of IBD treatment should occur simultaneously, as this improves both patient condition and response to iron therapy. Herein, we discuss the screening, diagnosis, selection of therapy, and follow-up for iron deficiency anaemia in IBD.

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Oral versus intravenous iron therapy in patients with inflammatory bowel disease and iron deficiency with and without anemia in Germany – a real-world evidence analysis

Cited by 18 publications

References 38 publications

Iron Therapy in Inflammatory Bowel Disease

Iron Therapy in Inflammatory Bowel Disease

Impact of Inflammation on Ferritin, Hepcidin and the Management of Iron Deficiency Anemia in Chronic Kidney Disease

Management of Iron Deficiency Anaemia in Inflammatory Bowel Disease

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